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KHOPOTSO BODIBE: Almost three months ago, in November, the nation received the good news that Cabinet had approved a national HIV and AIDS Treatment Plan. Where are we at the moment?
NONO SIMELELA: Yes, I think what is important to highlight is the fact that there is quite a significant amount of work that we needed to do and that we are currently doing to prepare for the implementation. First amongst these, obviously, is the development and finalisation of the treatment protocols, which we have managed to do with support from the HIV Clinicians’ Society and other experts within the country. We’ll start printing those guidelines in the second week of February. The training manuals: We have also asked for a tender for service providers which will be advertised next week to get universities and other institutions to assist us with training. The issues around the procurement: The team has met today (05/02/04) and they are meeting tomorrow to finalise the issues around procurement. We are hoping that as soon as they’re done with this and the tenders are out - probably in the next week, or so – for drug procurement we should start seeing forward movement. Obviously, the accreditation that has taken place should finish by the second week of February. Of the 105 facilities we have completed about 82 service points that we have evaluated.
KB: You’re mentioning a whole lot of factors here. In terms of drug procurement, what specifically is being discussed?
SIMELELA: The issues that are being discussed are the specifications for the tender; and the issues relate also to a medium to long-term strategy of procurement. As you know there are no companies [in South Africa] that make the active ingredients for the drugs that are in the protocols. So, they have to import the active ingredients. We’re looking at the strategies for international, regional and, obviously, country procurement. So, it’s all those things. The team has officials from Treasury, from DTI, from the Department of Health and other experts that are familiar with these processes.
KB: There’s also the issue of accreditation of the sites that will actually provide the service. You say 82 have been assessed?
SIMELELA: Yes, the accreditation process is quite intense. We have a whole set of factors that we evaluate: Does the facility have a laboratory; can the facility trace patients; what is the referral network up to the regional centre, down to the primary healthcare facility; how many doctors are there; how many nurses are there; where are they going to store the drugs? All those sorts of things are extremely critical. And, as we know, we do have a health system that needs to be upgraded significantly, especially in the most remote parts of our country. And that is the work that the teams have been doing in the provinces. And where gaps are being identified, provinces are developing plans to address these gaps against which they will then access their conditional grants and start procuring the things that they need because it is important to ensure that once patients are put on medication we can find them; that they understand what the medication can do. We don’t want a situation where patients don’t adhere, or patients don’t know where to go for follow-ups. So, it’s all those things that are really not new problems. HIV/AIDS has brought to the fore the problems that have existed in the health system all along.
KB: According to the Plan, the idea was to reach about 50 000 people by the end of this financial year March 2004.
SIMELELA: Yes, I think it’s important to remember that when the Plan was developed, it wasn’t developed in November. We started developing this Plan after the Cabinet had endorsed the Treasury report. So, it’s been almost four months in the making since July. So, when we made those calculations we made them based on an assumption that we would be much further in the Plan than we are right now. So, a decision came in November and unfortunately, it was like a week that was left after the 19th and then, a lot of the services closed down for Christmas. So, we are lagging behind in a way, but it was not because people didn’t do anything. We really were hit by the festive season where there wasn’t much we could do. People were away and all sorts of things, which are not really excuses but the reality was that we couldn’t move as fast as we had wanted. So, the numbers reflected our expectations then.
KB: In that case then, there should be a revised target. When are you aiming to achieve that?
SIMELELA: I think it’s difficult, as we’ve often said there are uncertainties about how many people will take up the service; how many people will be able to reach the facilities. It’s difficult for me to come up with absolute numbers on this matter.
KB: I understand you to be saying the 53 000 might have to be a target for some time next year and not by the end of this year.
SIMELELA: It’s realistic to say that we’re doing the best we can to fast-track. But, you know, the numbers shouldn’t be something that we bind ourselves to at this point because some things don’t work as fast or as much as you imagine. You know when you write something on paper the reality is slightly different. You know with the accreditations, for instance, we thought we could do it a little faster. But some of the facilities are far apart and the teams have to spend more time in one facility. The reality is slightly different from when you’re sitting as a team or a group in a room writing a plan. And I think that’s what I would love people to understand, that people are working hard on this Plan. There is no complacency. There is no sense of a lack of urgency. But, unfortunately, to get it right we need to make sure at the beginning we do the best we can to get things right.
KB: By when can we see the fist sites opening up to provide the service?
SIMELELA: Well, as soon as the drugs come into the country. We’re keenly awaiting the team to finish their discussions and tell us what their strategy is going to be and what the time-frames are. I can’t talk about lead times of how soon things come in because I don’t have that information. It depends on the pharmaceutical companies that will get the tender – how soon they can get the drugs into the country. So, I don’t necessarily want to bind myself to a time-frame that, if I don’t meet it, we then get attacked again to say you’re not sticking to the time-frames that you promised the country.
KB: There are a number of factors that need to be addressed – there’s the issue of putting out tenders for pharmaceutical companies, there’s also the issue of training, the issue of preparing the sites for the roll-out. All these take time, really. What deadlines have you set yourselves within which to work and make this a feasible project?
SIMELELA: Yes, we have set deadlines for ourselves within what we can control. Obviously, the training we can control as I said that tender for the service providers will go out. But in the meantime, we’re not sitting not doing anything. Provinces that have experience in this matter are assisting us and assisting other provinces. Provinces like Gauteng and the Western Cape who have experience - we’re getting the manuals from them. So, we’re not necessarily starting everything from scratch. And we have said to ourselves we should have at least have begun our training by the end of February, early March, so that we’re starting with the service providers in the service points that have been identified as first phase, and then the training will be on-going. So, our plans are aligned to targeting those areas where provinces have said this is where we want to start, which is why we are keen to see how many doctors are there; how many nurses are there. Even the allocation of community service doctors was done to sort of try and meet the needs of those service points. So, there has been a lot of thinking that has gone into this and, as I say, we have based our time-frames on getting everything ready, at least by March, so that whenever the drugs come they mustn’t come and find us not having done the training. So, we’ve put our time-frames to ensure that when the medications hit the facilities there are people trained to know what to do; there are patients already tested and staged, so that they can get the medication.
KB: Am I hearing you say that training has already begun?
SIMELELA: In some provinces, yes, like the Western Cape and Gauteng and some of the provinces have experts in the field who are willing to come in and do training. Remember, there has been training already for a significant number of health workers. What we need to do is just to make sure that it’s comprehensive; it focuses on the nutrition issues; it focuses on the adverse events; it focuses on adherence strategies as well. So, we’re building on the training that we’ve done previously for health workers in this area.
KB: At which sites is the training actually happening, can you name particular centres?
SIMELELA: The training happens almost on a mentorship programme, where the facilities providing the care – the nurses and doctors in that facility are being trained. We’re worried about taking health workers out of their work situation because there’s such a shortage. The training has been structured in such a way that it happens over weekends. It happens in a manner that it’s almost like in-service kind of training, on the spot, at the site. There will be some formal didactic training happening in formalised structures, but that is very, very limited. And we’re hoping to have also internet-based, web-based training, so that people can access the information.
KB: You spoke of the work that has been in provinces like the Western Cape and Gauteng. One can argue that those provinces that already have some know-how in administering ARV’s and managing HIV should start rolling out the service. It happened with the PMTCT and PEP services – aren’t you looking at this with this programme?
SIMELELA: Obviously, the provinces take responsibility for implementing. You will not see a uniform approach. Neither will you see one day everybody starts on that day because people are at different levels. There are provinces that have run HIV clinics, as you say, that already have patients waiting to be put on medication. There are provinces that have not reached that level. So, I think by default the nature of things is that we’ve tried to say those that can move should not be held back because others can’t move. But, we have to focus on the provinces that are not very well capacitated, so we don’t have a situation where people in villages feel discriminated against because they’re not necessarily accessing [treatment]. We’re scared also, of the overflow of patients moving from one province to another when there isn’t a service. So we’re keen to see that at least one service point in every health district in this country should be up and running.
KB: So, the implementation of the programme – as to when it does start, which centres actually start running is actually dependent on the provinces – can I deduce that?
SIMELELA: Yes, I think as the national Department we support. We provide guidance, we provide the framework, and in this financial year we have the bulk of the funding to procure the big cost items. So, we’re doing that preparatory work nationally, but at the end the provision of services is a provincial mandate and they are the people that will determine their capacity. We will support where there are shortages and constraints and it becomes ongoing.
KB: Do the provinces have the budget to run this already if they wanted to start this tomorrow?
SIMELELA: Well, in the allocation for 2004-2005, the money that was provided for the programme we have maintained nationally, so that we can pay the National Health Laboratory Services; we can do the tenders for the service providers; we can do the procurement for the drugs – in the first phase. But after the end of this financial year, 2004-2005, the provinces will have their own budgets to do their work.
KB: Is that dependent on the budget that Finance Minister Trevor Manuel is going to be announcing some time later this month?
SIMELELA: We’ll hear what is being announced, but definitely Treasury has made a commitment that we will get the finances we need to implement the programme. There is an understanding in principle, that this is not a programme you can start and stop. Government has said, when they endorsed the plan, it’s committed to make sure that financially the resources are available because you can’t not continue with the plan once you’ve started putting people on medication.
KB: When you announced the plan in November last year, something like R296 million was allocated for kick-starting the programme. Are you expecting this figure to increase, or as has been suggested in a report in the British Financial Mail, the budget will be cut?
SIMELELA: As I said earlier, when the plan was written we thought we would be much further down the line than we are at the moment. So, realistically, when the plan was endorsed in November we had four months in which to spend the money. Treasury allocated us R90 million for this financial year, which is what we are using. And from my own personal perspective it is realistic because if they had given us R300 million we would not have been able to spend it and people would still have criticised us because, really, we had a very short time-frame. If you look at November, we had a month. In December, we had two weeks off and then we had January and we are on the 5th of February now. So, if you put all of those times together it’s essentially just under eight weeks in which we have had to do everything. And if you look at the fiscus, you can’t expect a unit or a Department to be able to spend R300 million in four months. You run the risk of wasteful expenditure because you’re not thinking, you’re just running, running and trying to get the budget spent without critically thinking. We believe the R90 million is enough for the national Department to kick-start the process, beyond which the budgets for continuation are in the conditional grants for provinces.
KB: If I can get this clear. There are two figures – R296 million and R90 million?
SIMELELA: The R296 million in the plan was meant for the first quarter, which was from the time Cabinet took the decision to the end of the financial year, which is March 2004. So, Treasury gave us R90 million. They didn’t give us R296 million, which is reasonable because we would not have been able to use that money. As I said, the calculations were done way back when we had imagined or assumed we would have been able to start much earlier, based on the uptakes, based on what we would have had to procure then. So, R90 million is money we have had to spend from the end of November to the end of March. And beyond that, the medium term expenditure framework provides for conditional grants for the provinces; and the budget, which we will see when the Minister of Finance announces the revised budget how much we will get to take the Plan forward. And, obviously, the more patients who come on the programme, the more money we will need. And Treasury has said on that basis government will provide. I’m not necessarily worried about the fact that at some point we will run out of money because this is a commitment from government. And people understand that this is long-term, life-long therapy for people.
KB: With government, if you don’t spend your budget properly and to the maximum, you stand to lose your cut of the big cake the following financial year. How are you doing on spending your R90 million?
Dr. SIMELELA: We will have spent it by the end of March, the 31st. That is a fact. We will have spent that money.
KB: There is also a budget for nutrition as you’re recommending three treatment modes for HIV – nutrition, traditional medicines and ARV’s. Tell us how this will work?
SIMELELA: We will buy supplement meals for patients who are food insecure. We will provide micro-nutrients for all patients who are HIV infected. In terms of traditional medicines, what the plan says is that we will acknowledge the role of traditional medicines. But government is not in a position now to procure traditional medicines because we don’t know their safety, we don’t know their efficacy. We actually are working with the MRC [Medical Research Council] and other institutions to evaluate the safety and efficacy of such medicines. What we’ve said is that where patients are taking traditional medicines, we will document it. We will not discourage it, but we will try and follow up patients to see if there are any interactions between traditional medicines and antiretrovirals. So, what we have said and re-emphasised is that patients have a choice. People will not be forced to take anything that they are not willing to take. But, at least, when we’re providing the full comprehensive package, then people will be able to say “No, I don’t want antiretrovirals, I want to just have good nutrition”, we should be able to support that. And if they say “Well, I’m taking my traditional medications from my traditional practitioner”, we should be able to support that. We will not necessarily be able to procure it for patients, but we will not necessarily condemn them for using such interventions.
KB: What work has been done with traditional medical practitioners to help that particular segment of the programme?
SIMELELA: We have, in the national HIV/AIDS Directorate, two traditional healers, fully employed by the sub-unit to work with traditional healers. We’ve got eight provincial chapters where traditional chapters are working very closely with government. And, as I said, through the Medical Research Council, the Minister established a traditional indigenous knowledge arm of the MRC, which will evaluate these medicines. Remember, traditional health practitioners are not a homogeneous group of people. They are sangomas and others. So, it’s all a mix. We have said that they will set up a forum for them to monitor each other because doctors in the traditional Western experience will not necessarily be able to tell what is right, what is wrong, what’s working, what’s not working. So, there is a forum that the Minister has already established for traditional health practice in the country.
KB: When people start enrolling onto the programme where are you likely to find your patients? There have been suggestions that most likely it will be people who are already sick and in hospital who will be referred by the hospitals to sites providing treatment. Is that what you’re expecting – that the sickest of the sick are the ones who will be coming onto the programme initially?
SIMELELA: Yes, there are patients already in medical facilities whom we know are HIV infected, we know are manifesting AIDS diseases. So, I believe that these are the patients who will benefit first because they are in the facility. Patients in TB hospitals who are co-infected with HIV, if they are willing to be tested and go onto the programme, those are the first-line because they are there right in front of you. And then, we do have VCT [voluntary counselling and testing] in more than a thousand facilities in this country. We have PMTCT [prevention of mother to child transmission] as well. We have patients on the Diflucan programme, who we know already are HIV infected. So, we’ll be doing CD4 [tests] on those patients, and viral loads to stage them to know whether their CD4s are high or low and then refer them. So, I believe there is a ready pool of patients who will benefit. With time, like in many other countries, people will wait to see if this works or doesn’t work. And then, more and more people will come up for testing as they see that “Yes, government is really going to do this, and people are getting better.” It will become a natural evolution, that’s how I think about it.
KB: This may be a silly question, but some journalist-turned-expert-on-AIDS was speaking on radio, saying that with the proposed plan there is not so much of an emphasis on an HIV or AIDS test, but rather on a CD4 count of 200 or less. So, one would actually present for treatment, because they are immuno-suppressed regardless whether they’re positive or not. I would like to think that a low CD4 count is as a direct result of being HIV positive?
SIMELELA: No, I don’t think it’s possible. The way it happens is that patients or people will come in and say, “I’m willing to be tested”. It’s not just the CD4, it’s also the symptoms. In the guidelines with a CD4 of 200 and less with or, without symptoms, you have to be treated because you are immuno-suppressed. There are people with CD4 [counts] of nine that are walking around and are quite healthy. But they are not healthy in the true sense, because their immune system is really down. And they need to be treated. So, we’ve got different clinical criteria that will assist us. There isn’t anything like you can just walk in and not have a test. The CD4 is based on a positive HIV test.
KB: There’s apparently a report, which was carried out by the HSRC in 2002 on behalf of the Health Department, which suggests that about 46 % of people in public sector hospitals are HIV positive. Are you aware of this report – does it exist?
SIMELELA: Yes, we aware of the report, which is why I was saying that we know that there are patients in facilities that are ill - there is an awareness. That is why, I think, there has been this development of this policy. We’ve seen the burden on the health system as a result of HIV infection and AIDS and Tuberculosis. So, there is awareness that this is what is going to happen. There mustn’t be a perception that there will be this big mass of people suddenly dropping into facilities. People are there and they are ill. They need to just have their CD4 counts and viral loads done, so that they can come onto the treatment programme, if they choose to do that.
KB: Most of these people will be very ill when they present for treatment. Others will develop an infection once they are on treatment. This actually calls for a synergy of different services within a particular centre. How are you going to make sure that the programme is part of a whole set-up within the site?
SIMELELA: The programme is integrated in a sense that you will not have a stand-alone facility that’s an HIV clinic. No, it’s not going to be like that. When we talk about these accreditations, they’ve selected a central hospital where the treatment will be started. And then, there will be [a place] where they can refer very ill patients and when they get better they get discharged. So, we’re looking at the entire network: Who are the NGO’s, who will do the adherence, who will do the support. So, it’s the linkages up and down in the system. It’s integrated. It’s happening in the facilities that are already there. Some provinces will run their HIV/AIDS clinics on particular days. You’ll have Monday Diabetes, Tuesday Hyper-tension, Wednesday HIV/AIDS, Thursday whatever. It just depends on the provision. That’s why we’re leaving it to the provinces to decide how best they want to do this. HIV manifests in a way that patients come to the same facility. You won’t have: “These are just HIV patients. They are just sitting there”. If they’ve got TB they’ll be in a TB hospital with other patients who’ve got TB who are not HIV infected. And then they will be identified with a CD4 and then, they will be treated for their TB and then, when they get better, start antiretrovirals if they want to be on the programme.
KB: When it comes to human resources, for instance nutrition, the plan says there will be one dietician or nutritionist per 500 clients. How are you going to recruit these people, when are you advertising to fill these posts?
SIMELELA: The Human Resources cluster has been working very closely with the provincial health human resources departments to look at the scarce skills. What we’ve done in the training is that we will train even our lay-workers to understand nutrition issues. We’ll train the nurses as well. So, where you don’t have a specialised nutritionist the nurses will know how to give advice, the counsellors will know how to give advice, and we are also doing a training for NGOs to focus on nutrition issues. So, we’re trying to multi-skill the health workers, so that we don’t necessarily have too many specialists on the issue.
KB: Training is important for people who will be assisting with the roll-out. But it’s equally important to build awareness for the public around the plan – where to go, what they need to do, etc. When is that going to start?
SIMELELA: Just this morning I was signing off on one of the leaflets that we have developed. We’re working through the existing Khomanani tenders, through Johnnic and others, we’re working with Soul City who have developed the materials for us. The communications strategy has been developed and the pamphlets have been developed. We’ve just proof-read them this morning. You’ll start seeing in the next two weeks the adverts being flighted on TV and on radio and we’ll distribute to the small media by the end of February.
KB: So, most of the things are actually happening in two weeks’ time. Does that include drug procurement?
SIMELELA: Yes, as I said, the team is meeting as we speak. I don’t want to pre-empt what they are going to say. But, obviously, when they finish they understand the need to actually move. We’re hoping that in these meetings they will come up with specifications; that they’ll be able to send out the request for proposals. It’s the 5th of February today, so they should in the next week or so - two weeks, maybe - get out those tenders’ specs and be able to get us moving. And really, here, I need to be cautious because I’m not part of that team at the moment. And I don’t want them to be pressurised because of things I say when I’m not fully informed about what they are seeking to achieve. But I do know there is a commitment to ensure that they stay within our normal procurement regulations, but are able to move things forward.
KB: With regard to ensuring that the drugs are available and that there is a sustainable supply of drugs you will not be looking at only one supplier of a particular medicine, say for example, Efavirenz 50 mg for children. You won’t just rely on the company that’s responsible for marketing it in South Africa. You’ll look for one or two partners?
SIMELELA: Definitely. The plan is very specific about national and international tendering. We are cognisant of the fact that relying on one supplier is not the route to go. So, there will be multiple people coming to the table. And we also know with the pharmaceutical industry, it’s not one company that manufactures what we need. So, obviously, we have to source from different people. We have also built into the plan the fact that somewhere along the line we might need to change if we develop resistance, or if people don’t respond properly. So, those companies need to be ready to change strategy with us. We can’t bind ourselves to something that says we’ll buy from one company the same drug for the next three years. What if that drug is not working? What if there’s a problem? We have to be very flexible in the kind of contracts that get developed, so we don’t tie ourselves into a corner. And these are the things that the team is discussing, which are the things they are going to try to get the pharmaceuticals to agree to.
KB: Of the service centres that you have already studied, there are two figures. When you announced the plan 77 had been visited. Now you’re talking of 82. An update?
SIMELELA: People are in the provinces right now as we speak. At the end of this conversation I might get a report that they’ve finished Mpumalanga – two more sites. At the last count two weeks ago, they’d done 77. They’ve gone now to the next phase of the provinces. There are people in Mpumalanga and the Western Cape. They’ve done Limpopo. There are people finishing off in the Free State. I think they’ll finish Northern Cape next week. So, the numbers keep increasing as we get reports. But, we haven’t had an opportunity as a team to come back to base to say, “Okay, we’ve finished. This is what we’ve found”. The team has gone out since the beginning of Jan. We will re-group, probably in the middle of next week. We will be able to give a more comprehensive evaluation. And that is what is going to inform the next phase for the provinces as we hit the end of March. How and what they are going to need from their conditional grants to fill the gaps that we will have identified.
KB: What do you seek to identify with the accreditation process?
SIMELELA: The accreditation process is not meant to exclude. It’s really meant to identify what is missing, so we can actually bridge that gap. It’s not something that’s meant to say, “No, you can’t do it, you’re too poor. No.” It’s a tool that’s meant to identify things that are critical for us to provide the best service. And remember, when I say best service, it’s not just for AIDS, because if there wasn’t a laboratory there, and we can get a laboratory installed, it will do the specimens for everybody – for people with TB, with hyper-tension, with heart disease, whatever. So, it’s a broad strengthening of the entire health system. I think people have to remember that all the time. This is an opportunity for the health sector to improve. If the route is through a grant for HIV, then so be it. And as people get better and they get out of their beds and go home there’s space for other people with other illnesses because there are sick people who don’t necessarily have HIV in this country who also need care.
KB: Speaking of laboratories, is it a pre-requisite for every site to have a laboratory?
SIMELELA: They must have access to a laboratory. It might not be physically in that facility, it might be in another facility. But there is no way you can start patients on antiretrovirals if you don’t have the facility to monitor them. So, in some of these places the National Health Laboratory Service is looking at the transport issues, the courier systems. What we’re seeking is very short turn-around times, so we have the results as soon as we need them, and we can get moving. There isn’t a doctor in this country who’ll be willing to put patients on medication and not be assured that when he wants a liver function test, that that can be done in a short space of time. In places like Limpopo you can’t even get a blood sample done. People are dying because we don’t get blood results quickly enough. So, these are some of the tings we’re addressing in the accreditation and working with the NHLS.
KB: Does the National Health Laboratory Service have the capacity to deal with testing for HIV, viral loads, CD4 counts, and so on?
SIMELELA: Part of the R90 million we’ve been given is money that we will give to the NHLS to build up their services. I’m not quite sure how much, but a significant amount of that money is going to them to be able to start their processes in the provinces. They’ve already gone out on their tenders for CD4s and viral loads. They’ve already gone out on their tenders for other instrumentation that they need. The initial start-up funding for them will come from this budget that we have. The national department is doing all of that on behalf of provinces as a start-up procedure. But, subsequent to that as they start pulling the bloods and everything from the next financial year, then provinces will pay NHLS on a fee-for-service basis because we can’t predict how many specimens will come from province X and province Y. The provinces will manage that process in the next financial year. We’ll just be there to back up, to make sure we’ve got enough contingency funds to carry those provinces that have problems.
KB: What’s the relationship between the NHLS and the Department?
SIMELELA: They are contracted to provide the service to government.
KB: Any partnership with private laboratories?
SIMELELA: Yes, through the NHLS, because the way that the regulations go they are the preferred provider for the government. They do have a contract with the government. The private laboratories are willing to assist the NHLS where the NHLS is experiencing problems. But our relationship is with the NHLS and the NHLS can sub-contract to other people that we’re not prescribing to.
KB: To wrap up, you say there is no indication at the moment as to when a site, say, in Pofadder, will actually start functioning?
SIMELELA: No, I don’t want to tie myself to dates and times because, really, that is not something that is under my control. Not every part of the problem is something that we can manage effectively ourselves all the time. But, there is commitment to get this up and going and we’re all optimistic and positive. There will be challenges. I think people should realise that these medications do make people ill. We will have situations where we lose some of the patients and that information has to be communicated. That is the reality of starting a programme like this. We just want the partnership from everybody to support us as we move forward.
KB: Again, if I can just go back a little, here. Can a province actually start the programme without the go-ahead from national Department?
SIMELELA: I think what we’re seeking to achieve here is equity. We learnt a very hard and bitter lesson from the Prevention-of-Mother-To-Child-HIV-Transmission programme. You can’t say those who want or can move ahead shouldn’t because there are people who need care. But, we have a very strong focus on equity here. We want to make sure that people don’t trek from the Eastern Cape to Gauteng, just because Gauteng has the service. That will actually put Gauteng under pressure. So, we need to balance those things. And those are the challenges that we’ve had to face as we developed the plan. We need to be cognisant of the fact that the reality of South Africa is that there are places that have, there are places that don’t have. And we want to try and reach everybody. As it unfolds we will learn more.
KB: But I don’t think I’m following you. Are you saying that you will not prevent a province from implementing the programme if they think they are ready?
SIMELELA: That is not my decision, unfortunately. It’s not a decision that an official like myself can take. It’s a MINMEC decision, the MEC’s and the heads of departments make that decision. At this point I can’t say that they can seek permission from myself. There is consensus, there is a platform where the MECs and the minister [of health] make decisions on what they want to do and how they want to move forward. The MINMEC makes the final decisions on such matters. It’s not the HIV/AIDS unit that can do that. It’s a political decision.
This article is courtesy of Health-e News Service.
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